Context explains much of patient-perceived physician empathy in general practice

Abstract

Abstract Background. Patient-perceived physician empathy (PPPE) is associated with numerous positive outcomes for patients, quality of care and health expenditure. Research into the factors that explain PPPE is therefore crucial, but the focus has often been placed on physician-related predictors of PPPE. In general practice, however, many barriers to empathy may be contextual, such as lack of time, or patient-related, such as multimorbidity. Consequently, our aim was to explore the effect of these variables on PPPE in general practice. Methods. In a cross-sectional design, 50 randomly recruited physicians were compelled to include 20 consecutive adult patients with one or more chronic disease(s). The characteristics of the doctors and their work environment were collected (e.g. gender, age, peer-group participation or lack of participation, urban or rural area, working alone or with other colleagues, caseload, etc.). Physicians filled in patients’ diseases, and patients filled in validated questionnaires on their health, emotional skills (i.e their ability to identify, express and regulate emotions) and their perception of physician empathy (CARE scale). Multilevel linear regressions were performed using SAS. Results. The median PPPE was 45 (n = 762), with higher rates in patients who had had seven or more consultations with the physicians in the last 12 months and lower in patients with genitourinary and upper gastrointestinal diseases. In consultations ≤ 20 minutes, the length of consultation was associated with higher PPPE in interaction with patients’ emotional skills: the positive effect of longer consultations on PPPE was stronger in patients with low emotional skills, whereas patients with high emotional skills were able to perceive high empathy even in very short consultations of 5–10 minutes. Among the 11 physician-related candidate variables, only physician age had a significant effect. Conclusions. Patient-related and, especially, contextual variables explained PPPE much more than physician-related variables. Consultations with infrequently seen patients and patients with low emotional skills should ideally last at least 20 minutes to allow the empathic process to unfold. Patients with genitourinary and upper-gastrointestinal diseases should be given special consideration, as they may encounter intimate issues or specific needs requiring more attention.